6.1.2 Antidiabetic drugs

General Advice

  • Refer to COMPASS Therapeutic Notes for further information on the management of type 2 diabetes. For a summary of oral drug treatments for type 2 diabetes click here.
  • First-line treatment for management of type 2 diabetes is usually a trial of dietary therapy alone unless there is intercurrent infection, severe hyperglycaemia or severe osmotic symptoms. Lifestyle and dietary modifications form the cornerstone of therapy and should be reinforced at every opportunity.
  • Patients commencing blood glucose lowering agents may need to inform the DVLA and their vehicle insurance company. Advise patients to check with their insurer and the GOV.UK website.
  • Women with type 2 diabetes who become pregnant whilst taking antidiabetic medication should be referred urgently for specialist advice. It is safe to continue metformin. See NICE NG3 on diabetes in pregnancy.
  • See NG28 on type 2 diabetes for full advice. A NICE patient decision aid is available to discuss the options with the patient.
  • Visit the Think Kidneys website to find help and advice for people with Chronic Kidney Disease (CKD).

Cautions

Oral hypoglycaemics in elderly patients

  • Certain aspects of type 2 diabetes in elderly patients require special consideration. Drug-induced hypoglycaemia is one of the most serious potential complications.
  • Risk of hypoglycaemia is increased when combination therapy is used.
  • Risk of hypoglycaemia is increased with renal impairment. Decreased renal function in elderly subjects is frequent and asymptomatic. Special caution should be exercised in situations where renal function may become impaired, for example when initiating antihypertensive therapy or diuretic therapy and when starting therapy with a non-steroidal anti-inflammatory drug (NSAID).